At an Irving community center in late 2013, navigator Andrew Moura helped Debbie Sands sign up for insurance under the Affordable Care Act.

Update at 4:23 p.m.: Have added comment from United Way of Tarrant County chief executive Tim McKinney.

Original item at 3:34 p.m.: Federal health officials on Monday awarded a second round of grants so six Texas nonprofits and one municipal agency can hire “navigators” who help people sign up for insurance under the Affordable Care Act.

“We are committed to helping Texans get covered and stay covered with in-person assistance in their own communities,” U.S. Health and Human Services Secretary Sylvia Burwell said in a statement.

As was true last year, Burwell’s department awarded 16 percent of her national navigator budget to Texas — about twice its share of U.S. population.

Texas has the highest share of its population uninsured of any state — 23.8 percent before the provisions of the law kicked in.

Texas’ Republican leaders, though, have refused to have anything to do with the federal health care overhaul. Leaders opted against running one of the law’s online, state health insurance exchanges, or marketplaces. They rebuffed huge financial incentives for adding poor, able-bodied adults under 65 to the Medicaid rolls.

The navigator program, which hit the streets last fall and winter, also drew state leaders’ ire. In Monday’s announcement, there was at least one sign that the federal department listened:

Federal officials did not renew the National Urban League’s navigator grant, which at $377,000 was the smallest of eight awards they made in Texas last year. As GOP U.S. House members highlighted at a special field hearing in Richardson in December, three Urban League of Greater Dallas “navigators in training” and a trainee receptionist were caught misbehaving on hidden camera by conservative activist James O’Keefe. The women were heard urging actors posing as applicants to try to get a better deal in the exchange by lying about their income or tobacco use. The league suspended the three navigators in training and fired the trainee receptionist.

Nearly half of the $9.7 million awarded in Texas — $4.6 million — will go to a consortium led by United Way of Tarrant County. In Dallas and Collin counties, the money flows through the Community Council of Greater Dallas, which is a subcontractor of the Fort Worth-based United Way.

While the consortium’s grant was cut by nearly $1.3 million, United Way of Tarrant County chief executive Tim McKinney said that reflects decisions to remove Houston and some rural counties from its service area. He noted that the city of Houston’s health and human services department, formerly a member of the consortium, applied on its own this year and won a $1.8 million grant.

“We received the amount that we requested so we are elated,” McKinney said.

In East Texas, a network of 11 community centers for the mentally ill and developmentally disabled received a grant for the second time — of just over $1 million.

The United Way of El Paso, which received a $640,000 grant last year, did not receive a new one. That raises a question of whether El Paso will receive any federally paid navigators. The new enrollment period in the marketplaces begins on Nov. 15.

Last year, state GOP leaders criticized the federal department for insufficiently vetting and training the navigators. Gov. Rick Perry’s insurance commissioner, Julia Rathgeber, imposed new state fingerprinting and education requirements.

According to Stacey Pogue, an analyst at the center-left think tank the Center for Public Policy Priorities who keeps tabs on the navigator program, the state registration went pretty smoothly.

Grant recipients worked hard to get their newly hired employees over the new state hurdles, and state insurance regulators moved quickly to process their applications, she said. The 20 hours of state required training and some delays at private fingerprinting vendors caused navigators to see fewer of the federally run state marketplace’s prospective customers than if Texas had not intervened, she said.

“In the end, though, there was little drama in how it played out,” Pogue said.

Financial counselor Ricky Spain answers questions for people waiting to sign up for health insurance at the business office of Parkland Memorial Hospital in Dallas.

Round two of Obamacare enrollment starts Nov. 15. But a group promoting signups wants Texas’ 5 million uninsured adults between the ages of 18 and 64 to know that as many as 365,000 of them are eligible today to go online and enroll in the federally run health insurance marketplace.

Wasn’t the deadline March 31?

Yes, but if you move to another county, get married, have or adopt a child or gain citizenship, you have had what the Affordable Care Act deems a life-changing event that triggers a special enrollment period — right now.

On Tuesday, the group Enroll America and its Get Covered America campaign, which operates in Texas and 10 other states, released a report estimating that 365,691 uninsured adult Texans will experience one or more of those qualifying events in the 7 1/2 months between enrollment periods.

Mimi Garcia, Texas director of Get Covered America, noted that there also are more than 800,000 Texas children who qualify for but are not enrolled in Medicaid and the Children’s Health Insurance Program.

Texas did not expand Medicaid for adults, as envisioned under the federal health care overhaul. State GOP leaders said Medicaid is too costly and inefficient, and that Congress could renege on the law’s promise that the federal government will pay at least 90 percent of the expansion’s cost. The expansion was expected to sweep in “welcome mat” children, as parents considered their options. For the most part, that didn’t happen.

“Hundreds of thousands of Texans, especially children, qualify right now,” Garcia said in a statement.

Christine Sinatra, state spokewoman for Enroll America, said the group is working with businesses and community groups to spread the word about adults who could sign up for marketplace coverage immediately as well as youngsters who’ve been eligible for the government health insurance programs for some time.

“We’ve been out to dozens of back to school events across the state,” Sinatra said. “For a sizable number of Texans who are uninsured, there isn’t a need to wait.”

Although a poll last week showed that a plurality of Texans favor Medicaid expansion, don’t expect any of the four Republicans running in a special election for Texas Senate to salute that flag.

In fact, one of the four, Rep. Brandon Creighton, aired a cable TV ad on Tuesday that makes a virtue of his resistance last year to enlarging the Medicaid program for the poor.

“Brandon fought against Democrats and Republicans to stop the expansion of Medicaid under ObamaCare in Texas,” says the ad, which you can see below. “That’s why RedState.com said Brandon Creighton is a fighter in the mold of Ted Cruz,” says a narrator, referring to a conservative blogger’s post. It sort of simplified a tussle between Creighton, R-Conroe, and House Speaker Joe Straus, R-San Antonio. But that’s another story.

While many mainstream Republicans, including former Senate Finance Committee Chairman Tommy Williams of The Woodlands, wanted the state to take a look-see at a possible “Texas solution,” staunch conservatives considered that squishy and unacceptable. Under a Texas solution, the state would have insisted that federal officials let it use private insurance, charge co-pays and demand personal responsibility from the new adults gaining Medicaid cards.

According to the new poll, the broader public in Texas may have some appetite for trying to grab some of the additional money from the feds that the Affordable Care Act offers. The poll by Public Policy Polling, a Democratic firm in North Carolina, noted in its question that federal money was on the table before it asked:

“Do you think the Texas state government should accept this federal funding to expand Medicaid coverage, or not?”

By a 49-35 margin, respondents said Texas should. Sixteen percent were unsure.

While Democrats were 8-to-1 in favor, Republicans were only 2-to-1 against. Independents broke 48 percent in favor, 34 percent against.

And the only age cohort in which Medicaid expansion was losing was among those over 65. The poll of 559 registered voters was conducted April 10-13 and has a margin of error of 4.1 percent in either direction. Most of the interviews were conducted by phone, with 20 percent contacted by Internet to reach respondents who don’t have a land line telephone.

Creighton, left, drew notice in 2009 as House sponsor of a symbolic resolution re-affirming Texas' sovereignty under the 10th Amendment to the U.S. Constitution. But he's not the only tea party favorite in a special Texas Senate election on May 10.

Williams has resigned his southeast Texas Senate seat, and Gov. Rick Perry called a May 10 special election. Although it includes the former Democratic stronghold of Jefferson County (Beaumont), no Democrat filed. All four candidates are Republicans from Montgomery County in exurban Houston: Creighton, who was elected to the House in 2006; freshman Rep. Steve Toth of The Woodlands; former Sen. Michael Galloway, who served a term in the 1990s; and businessman Gordy Bunch, who sits on The Woodlands township board.

Both Toth and Creighton, who was chairman of the House Republican Caucus last year, have tea party credentials.

Creighton earned his spurs in the 2009 session with a state-sovereignty resolution. Almost simultaneously, he and Perry foreshadowed what a rising force the tea party would become.

Now, Creighton is linking his defense of states’ rights to the Medicaid expansion allowed under President Barack Obama’s health care law.

“We’re pushing back on the 10th Amendment, using the opening [Supreme Court Chief Justice] John Roberts left us, that is the ability to say ‘no’ to Medicaid expansion,” he told me Tuesday. Creighton said he’s also urging drug testing of entitlement program beneficiaries. His new 60-second radio ad has time to plug his sponsorship of a bill requiring drug screens and tests of unemployment compensation applicants.

The maps for the Legislature and U.S. House are drawn to amplify Republican strength in Texas. That may be why you won’t hear too much about Medicaid expansion in this year’s elections.

Texas Gov. Rick Perry, backed up by a solidly Republican Legislature, has you beat.

Researchers Katie Keith and Kevin Lucia of Georgetown University’s Center on Health Insurance Reforms looked at not only whether states expanded Medicaid to cover working-age adults who are poor and lifted a finger to help U.S. Health and Human Services Secretary Kathleen Sebelius launch each state’s online insurance marketplace. In their report, Keith and Lucia also examined less well publicized features of President Barack Obama’s signature health care law, such as whether a state insurance department is helping with “plan management” — that is, making sure all policies offered in the marketplace with the new rules designed to end insurance underwriting abuses.

Thirty-two states have done at least something to help police the marketplaces, or exchanges, according to their study. It was conducted for The Commonwealth Fund, a nonprofit health group now headed by physician David Blumenthal, who helped oversee the federal push for the adoption of electronic records under Sebelius and Obama. But the feds are having to directly enforce market rules and respond to consumer complaints in five states. You guessed it: They’re the fiercely resistant five.

There may be seven states fully embracing Obamacare, the authors write: Connecticut, Hawaii, Maryland, Massachusetts, Minnesota, Oregon, and Vermont.

“At the other end, five states — Alabama, Missouri, Oklahoma, Texas, and Wyoming — declined to play a role in implementing the law’s three major components,” they said. “These states will not enforce the market reforms, will have a federally facilitated marketplace where the state will play no formal role, and declined to expand Medicaid.”

Tim McKinney, president and chief executive of United Way of Tarrant County

Texas’ biggest employer of Obamacare “navigators” says his charity and the 15 other organizations it works with across the state will obey an expected edict from Gov. Rick Perry’s administration calling for more training and background checks.

“Our navigators will comply with any regulation and rules that are enacted,” United Way of Tarrant County chief executive Tim McKinney said Wednesday.

He was referring to the federally paid workers who advise consumers about their options in new online state health insurance exchanges.

McKinney clearly wasn’t thrilled about one part of the Texas Department of Insurance’s proposed rule, issued Tuesday. It would require navigators to take 40 hours of additional course work – on top of the 20 hours to 30 hours they’ve already had, under federal guidelines.

“That’s 40 hours that they could be spending doing what they have been trained to do — educate and inform eligible consumers about the marketplace,” he said.

It’s possible, though, that existing navigators could defer some of the additional course work until next spring. That could help them stay focused on an upcoming deadline for people who want to obtain federal subsidies under the Affordable Care Act. Under the law, people have until March 31 to enroll in private plans offered in the exchanges, also known as marketplaces.

On Tuesday, Insurance Commissioner Julia Rathgeber gave the public until Jan. 6 to comment on her proposed rule. If it’s adopted early next month, navigators would have to register with the state, starting March 1, department spokesman John Greeley said Wednesday in an email. They would have until May 1 to complete the educational requirements, he said.

Perry and other Texas Republicans have said Texans could fall prey to identity theft if there isn’t more thorough vetting of navigators. As we reported in this story in Wednesday’s newspaper, though, a leading Democratic lawmaker and a consumer advocate complained the state rule potentially could cripple efforts to educate uninsured Texans.

Stacey Pogue of the Center for Public Policy Priorities

Consumer advocate Stacey Pogue of the center-left think tank the Center for Public Policy Priorities says the rule would add $330 to $990 of cost per navigator who would have to register with Rathgeber’s department.

In an organization that hired 30 navigators, she said, that would add up to about $30,000 — or enough to wipe out the job of “a full-time navigator who could be assisting the uninsured.”

McKinney said he and his group, the Consumer Health Insurance Marketplace Enrollment Services or CHIMES consortium, haven’t been able to calculate how much the rule would cost.

“Organizational costs will obviously come from the grant,” he said.

In August, CHIMES received a $5.9 million federal grant – or 54 percent of the $10.9 million awarded in Texas.

It has hired 140 navigators, McKinney said. It voluntarily ran them through a $15-per-person, Texas Department of Public Safety background check. Under the state rule, it would have to spend as much as $60 more to have the FBI run a fingerprint check on each, Pogue said.

McKinney’s group also voluntarily gave its navigators an additional 90 minutes of training about privacy, beyond the federally prescribed curriculum, he said.

Update at 6:35 p.m.: There is at least some Democratic support for extending risk pool coverage for a few months.

On Friday, Sen. Kirk Watson, D-Austin, wrote Rathgeber to endorse an extension of coverage for at least 90 days. He noted that under the federal law, enrollees in the new state exchanges or marketplaces must sign up and pay by Dec. 15, to avoid any interruption in coverage, which begins Jan. 1.

“Today, we do not have assurance that problems with the www.HealthCare.gov online application will be resolved by the Dec. 15 deadline,” Watson said.

Update at 5:09 p.m.: Insurance Department spokesman John Greeley said late Monday that the department is “carefully monitoring” the risk pool’s situation and has discussed with state leaders the possibility of extending coverage for current enrollees.

“We are currently working through the mechanics of how an extension of coverage might be accomplished,” he said in an email.

Original item at 4:27 p.m.: Lambasting the federal health law as “deeply flawed” and an “abject failure,” Lt. Gov. David Dewhurst on Monday asked the Texas Department of Insurance to delay shutting down a high risk insurance pool that helps nearly 23,000 Texans.

But Dewhurst said it should be prolonged. He did not specify for how long.

In a letter to Insurance Commissioner Julia Rathgeber, his former aide, Dewhurst said President Barack Obama’s rollout of the Affordable Care Act has been “an abject failure.”

The clunky federal website HealthCare.gov “has left far too many of our vulnerable citizens with no clear path to coverage,” he wrote. Pool beneficiaries can’t “make rational decisions about their options due to the confusing, incomplete information being provided by the Obama administration,” he said.

Dewhurst is seeking a fourth four-year term as lieutenant governor. He faces three stout opponents in the March 4 Republican primary.

A Rathgeber spokesman had no immediate comment on whether and how the department would respond.

Launched in 1998, the state pool is run by a board appointed by the state insurance commissioner. It uses no state funds. Last year, it assessed commercial health insurance companies about $165 million, based on their share of the Texas market.

With that money, the pool subsidizes coverage. It caps premiums at twice the rates charged in the state-regulated individual market, in which people buy coverage with no help from an employer.

Last month, the pool covered 22,912 people. Most were people who had been rejected or priced out of the individual market.

Nationally, 35 states have created such pools, which covered about 222,000 people at the end of 2010, according to a report by the National Conference of State Legislatures. About half planned to close their doors soon because under the federal law, starting Jan. 1, insurers must accept all customers regardless of health history. The insurers may vary premiums only slightly, to reflect age differences.

In a separate program, the federal health law also created high risk pools. It sought to help people with chronic conditions in all 50 states between 2010 and 2014, when the law’s major features kick in — insurance exchanges, subsidies and an end to such insurance underwriting practices as denial for pre-existing conditions.

As of April 30, there were 110,298 people enrolled in the federally subsidized pools — 9,125 of them in Texas. It was among 40 states that declined to run their own version of the federal pool, according to the legislatures group.

Freshly minted comptroller candidate Mike Collier says he’s “very much at home in the Democratic Party,” even though he voted for Mitt Romney in the 2012 GOP presidential primary.

“I’ve always voted for the person,” Collier, a Kingwood businessman and accountant, said in an interview Tuesday. Earlier, he filed papers for his long-shot candidacy.

“Did you see who Romney was running against,” Collier said. “I voted against all of those other guys.”

One of the “other guys” was Gov. Rick Perry.

Collier said he wished he’d been comptroller the past few years, so he could have called press conferences on the spot after Perry told some whoppers.

What kind of Perry whoppers?

“I was really unhappy in January of this year … with Governor Perry pounding his chest, saying our record of investing in education is phenomenal,” Collier said. “It isn’t phenomenal. It’s abysmal.”

He said a comptroller reality check also would’ve been in order when Perry claimed that Medicaid expansion under the federal health law would bankrupt the state.

“That has no basis in fact,” Collier said.

He said the business people he meets say there needs to be “an internal control” in state government, especially in the financial office of comptroller.

“They step back and say, ‘Why would you do anything but have a Democrat in that role, when the Legislature’s Republican?’” he said.

Many politicians, of course, like to ask questions they then answer. But how many pepper their comments with sexy phrases such as “internal control?”

This one does. For many years, Collier was a CPA. He headed PriceWaterhouseCoopers’ Houston division, before jumping into the oil business two years ago.

Last month, as we noted here, Collier announced he’d run to succeed retiring Comptroller Susan Combs. On Tuesday, he said he got into the race because he’s mad about the 2011 budget cuts to schools and the Legislature’s repeated refusal to maintain adequate funding of public schools and indigent health care, which he said keeps local property taxes high. He said 2012 was the only time he ever voted in a primary. In 2010, he said he strongly backed former Houston Mayor Bill White, a Democrat, for governor.

“There’s no room for me in the Republican Party,” Collier said, noting he favors abortion rights and gay marriage.

“Fiscally, I’m reasonable,” he said. He laid into “destructive” Texas Republicans, who he said refuse to do smart things, such as put more state money into roads, water projects and programs for young children with limited proficiency in English.

Collier said that to date, he’s received about $250,000 in contributions. He said he’d like to raise the $7.5 million Democrat Paul Hobby raised in a failed bid for comptroller 15 years ago.

“I’d love to do that,” he said. “But three to five [million] is what I have in mind” as a target.

Attorney General Greg Abbott, at a press conference in Dallas on Monday

Updated at 11:10 a.m.: U.S. Rep. Randy Weber, R-Friendswood, has released a letter to Gov. Rick Perry that he authored last Friday and that the 23 other Republicans in the Texas congressional delegation signed. It sings from the same hymn book as Abbott and Perry. It says Texas must act to make sure “federal healthcare exchange navigators are properly vetted, trained and state-certified.” However, Weber & Co. depart from Abbott in one regard: They are still saying “amen” to Perry’s call for a rule making navigators submit to the insurance department the names of people they sign up for insurance through the exchange, and locations at which sign ups occur. Under federal regulations, that’s a no-no. Abbott’s silent on the matter. Note: We’ve also corrected the acronym for an older federal law, HIPAA.

Original post at 9:09 a.m.: Attorney General Greg Abbott has cited about a half dozen shortcomings in federal rules governing the “navigators” hired under federal grants to help people sign up for insurance under Obamacare. The various “insufficiencies” mean Texas will have to issue its own, tougher regulations, Abbott said in a letter to Insurance Commissioner Julia Rathgeber on Tuesday.

Among the flaws Abbott says his and Rathgeber’s agencies have identified:

* Navigators should undergo criminal background checks before they’re hired, convicted felons should be rejected and navigators should have more training in the 1996 federal health privacy law known as HIPAA, or the Health Insurance Portability and Accountability Act. (The biggest recipient of the federal navigator grants in Texas, a 17-member consortium led by United Way of Tarrant County, has voluntarily done criminal background checks on all of the 75 navigators it hired and given them special training on HIPAA, officials said.)

* While the federal rules require reports of security breaches to the U.S. Department of Health and Human Services, that isn’t enough. Navigators should be required to immediately notify the affected individuals and undergo more training on all the state and federal privacy laws and the steps they should follow in the event of such a breach.

Abbott does not mention one demand Gov. Rick Perry made this fall: Perry suggested the state Insurance Department require navigators to report to it the names of all consumers they help and where they helped the consumers. Experts said that would violate the federal rules, which forbid navigators from keeping names and personal information on the people they help.

Rathgeber has not moved to issue emergency regulations. As we reported in this Sept. 30 story, she must carefully navigate a new state law that requires her to try to work with the feds to iron out problems with the navigator rules. We had this story on Abbott’s letter in Wednesday’s print editions. You can read the letter below.

Sen. Kirk Watson, D-Austin, makes a point in last summer's first special session.

Update at 3:49 p.m.: State insurance department spokesman John Greeley says the department “received letters from some members of the Texas Conservative Coalition and numerous elected officials with concerns about ACA navigators. The concerns raised in the letters included the lack of adequate regulations to protect consumers from having their personal information misused and poorly defined federal training standards for navigators.” The department isn’t considering adopting emergency rules, to speed up the process, he said. Regular rules take a minimum of “several weeks” to issue, he said.

Original item at 3:26 p.m.: Advocates for the poor and Democratic lawmakers urged the state Monday to delay issuing rules on health “navigators” until it can show that federal regulations and training have failed to protect Texas consumers.

Gov. Rick Perry has asked state insurance regulators to require that fingerprints be used in background checks of prospective navigators and that they undergo additional instruction on protecting people’s privacy.

Navigators are a small group of federally funded workers now being hired by several Texas nonprofits. Starting this week, navigators trained and certified under federal rules can begin helping people who want to explore their options for coverage under the federal health care law.

While Perry nearly two weeks ago asked for state rules more stringent than federal safeguards, the process of issuing state regulations has just begun. And it can be lengthy.

Federal health officials have criticized Perry’s move as “a blatant attempt to add cumbersome requirements” designed to slow enrollment in health plans. However, the federal government hasn’t funded enough navigators to put more than a dent in the state’s more than 6 million people lacking insurance. And so the flap, for now, is mostly symbolic — hardly make or break for Obamacare in Texas.

No federal official appeared at Monday’s informal meeting, despite a state invitation. The Texas Department of Insurance held the meeting for interested parties. It hasn’t said whether a state rule definitely will be issued, only that it’s looking at “concerns” raised by unidentified people who have written it letters. A reporter’s request for information about the letters went unheeded late Monday.

At least initially, navigators can go about their work unimpeded by the Republican governor’s proposed requirements. Perry wants navigators to have to pay a state licensing fee and take 40 extra hours of course work, on top of the 20 hours required the U.S. Department of Health and Human Services.

Senate Democratic leader Kirk Watson of Austin testified that Perry’s call for state regulations was premature.

Update at 5:35 p.m.: I’ve corrected the date of the next presidential election. It’s 2016, not 2014.

Original item at 12:06 p.m.: Ted Cruz literally willed himself into the U.S. Senate. So it’s not surprising he has a strong ego.

His recent antics, though, have inspired a poster suggesting he’s on one big ego trip.

It’s a knock off of the Barack Obama campaign placard in 2008 that alternated the words “Hope” and “Change.”

In the Cruz parody, those words are replaced by “Me.”

Cruz launched a filibuster-style talkathon that ran overnight Tuesday. He said he wanted to force the Senate to accept a House-passed continuing resolution that keeps the federal government funded beyond Monday and that, crucially, would strip away all money for Obama’s federal health care overhaul.

The Senate isn’t bowing to Cruz’s will. The outcome, though, is unclear. Both a government shutdown and a national default, if the federal debt ceiling isn’t raised by Oct. 17, are possible.

Cruz may have endeared himself with staunch conservatives, helping his nascent 2016 presidential bid. And he’s certainly raised his name recognition outside Texas.

He gets credit in some quarters for grit and physical stamina. After all, Cruz said during his 2012 campaign that he would lay his body down on the tracks to stop Obamacare. In a sense, he’s made good on his pledge: He laid down his vocal cords, at least.

But Cruz is rapidly collecting enemies. Positioning himself as an outsider, he probably loves this. Still, the possible harm to the economy that could flow from his tying the health care law to urgent fiscal housekeeping measures makes it possible he’ll be blamed as reckless.

Cruz critics are planting that accusation in the soil of public opinion. “His time on the Senate floor was an exercise in self-promotion,” acerbic Washington Post columnist Dana Milbank, a liberal, said in a piece published Thursday.

This followed public questioning of Cruz’s judgment last week by GOP senators such as Bob Corker of Tennessee and Orrin Hatch of Utah. In a story in Politico, they basically said he wants Republicans to overplay their hand.

Cruz’s fate is now tied to events. He could be the conservative movement’s hero. Or his party’s goat. But one thing is clear: He’ll be a poster child for something.